Table 3:

Endovascular therapy quality improvement case review triggers and process metrics

Indications for Endovascular Treatment

  • Metric 1: At least 90% of patients who meet the institution selection criteria (indications/contraindications) should be treated with endovascular therapy.

Data Collection

  • Metric 2: 100% of patients have the required minimum process and outcomes data entered into an institutional or national data base, trial, or registry.

Key Time Intervals
Door to imaging

  • Metric 3: 75% of patients being evaluated for revascularization should have imaging initiated within 30 minutes from time of arrival. At the best of centers with high volumes and an established resource infrastructure, this is expected to be achieved in 12 minutes.

Imaging to puncture

  • Metric 4: 75% of patients treated with endovascular therapy should have an imaging-to-puncture time of 110 minutes or less. At the best of centers with high volumes and an established resource infrastructure, this is expected to be achieved in 50 minutes or less.

  • Metric 5: For patients transferred from another site and in whom imaging is not repeated, 75% of patients being treated should have a door-to-puncture time of 80 minutes or less.

Puncture to revascularization

  • Metric 6: In 70% of patients, mTICI score ≥2b should be reached ideally within 60 minutes of arterial puncture.

Outcome Metrics
Recanalization/reperfusion

  • Metric 7: The mTICI scale should be the primary scale used to assess angiographic reperfusion.

  • Metric 8: At least 70% of patients should have an mTICI score ≥2b/3 (>50% reperfusion) for all clot locations.

Postprocedure CT/MR Imaging

  • Metric 9: At least 90% of patients should have a brain CT or MR imaging within 36 hours of the end of the procedure.

SICH

  • Metric 10: 100% of cases with SICH are reviewed.

  • Metric 11: No more than 10% of treated patients should develop SICH.

Embolization of new territory

  • Metric 12: No more than 10% of patients should have embolization of new territory.

Death within 72 hours of treatment

  • Metric 13: 100% of cases of death within 72 hours of the end of the procedure are reviewed.

Clinical Outcomes

  • Metric 14: All treated patients have a documented NIHSS score at discharge. Attempts are made to contact and document a follow-up mRS score at 90 days (evaluated in person or via telephone) on all treated patients. At least 90% of treated patients have a documented 90-day mRS score.

  • Metric 15: Of all treated patients, at least 30% are independent (ie, mRS score 0–2) at 90 days after treatment.

  • Note:—mRS indicates modified Rankin Scale; mTICI, modified thrombolysis in cerebral infarction; NIHSS, National Institutes of Health Stroke Scale; SICH, symptomatic intracranial hemorrhage.